NCLEX Urinary

7/23/2019 NCLEX Urinary

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NCLEX Urinary/Renal

Function/Disorder and Electrolyte

ImbalanceA client with urinary incontinence asks the nurse orsu!!estions about mana!in! this condition" #hichsu!!estion would be most a$$ro$riate%

a& '(ake sure to eat enou!h )ber to $re*entconsti$ation"'b& '+ry drinkin! co,ee throu!hout the day"'

c& 'Use scented $owders to dis!uise any odor"'d& 'Limit the number o times you urinate durin! theday"'a& '(ake sure to eat enou!h )ber to $re*entconsti$ation"'E-$lanation. u!!estions to mana!e urinaryincontinence include a*oidin! consti$ation such aseatin! ade0uate )ber and drinkin! ade0uate amounts o1uid" cented $owders2 lotions2 or s$rays should bea*oided because they can intensiy the urine odor2irritate the skin2 or cause a skin inection" timulantssuch as ca,eine2 alcohol2 and as$artame should bea*oided" +he client should *oid re!ularly2 a$$ro-imatelye*ery 3 to 4 hours to ensure bladder em$tyin!"

A client is rustrated and embarrassed by urinaryincontinence" #hich measure should the nurse includein a bladder retrainin! $ro!ram%a& Restrictin! 1uid intake to reduce the need to *oidb& Establishin! a $redetermined 1uid intake $attern orthe clientc& Encoura!in! the client to increase the time between

*oidin!sd& Assessin! $resent *oidin! $atternsD& Assessin! $resent *oidin! $atternsE-$lanation. +he !uidelines or initiatin! bladderretrainin! include assessin! the client5s $resent intake$atterns2 *oidin! $atterns2 and reasons or eachaccidental *oidin!" Lowerin! the client5s 1uid intakewon5t reduce or $re*ent incontinence" +he client shouldbe encoura!ed to drink 6"7 to 3 L o water $er day" A*oidin! schedule should be established aterassessment"


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A nursin! instructor is re*iewin! with the class theste$s in urine ormation" 8lace in the correct orderrom )rst to last the se0uence the instructor would$resent"9Filtrate enters :owman5s ca$sule

98lasma )ltered throu!h !lomerulus9Formed urine drains rom the collectin! tubules2 intothe renal $el*is2 and down each ureter to the bladder9Filtrate mo*es throu!h tubular system o the ne$hronand is either reabsor$ed or e-creted98lasma )ltered throu!h !lomerulus9Filtrate enters :owman5s ca$sule9Filtrate mo*es throu!h tubular system o the ne$hronand is either reabsor$ed or e-creted9Formed urine drains rom the collectin! tubules2 intothe renal $el*is2 and down each ureter to the bladder

A client is admitted or treatment o chronic renalailure ;CRF&" +he nurse knows that this disorderincreases the client5s risk o.a& a decreased serum $hos$hate le*el secondary tokidney ailure"b& an increased serum calcium le*el secondary tokidney ailure"c& water and sodium retention secondary to a se*eredecrease in the !lomerular )ltration rate"d& metabolic alkalosis secondary to retention o

hydro!en ions"C& water and sodium retention secondary to a se*eredecrease in the !lomerular )ltration rate"E-$lanation. +he client with CRF is at risk or 1uidimbalance < dehydration i the kidneys ail toconcentrate urine2 or 1uid retention i the kidneys ail to$roduce urine" Electrolyte imbalances associated withthis disorder result rom the kidneys5 inability to e-crete$hos$horus= such imbalances may lead tohy$er$hos$hatemia with reci$rocal hy$ocalcemia" CRFmay cause metabolic acidosis2 not metabolic alkalosis2

secondary to inability o the kidneys to e-cretehydro!en ions"

#hich is the correct term or the ability o the kidneysto clear solutes rom the $lasma%a& >lomerular )ltration rate ;>FR&b& Renal clearancec& $eci)c !ra*ityd& +ubular secretion:& Renal ClearanceE-$lanation. Renal clearance reers to the ability o the

kidneys to clear solutes rom the $lasma" >FR is the*olume o $lasma )ltered at the !lomerulus into the


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kidney tubules each minute" $eci)c !ra*ity re1ects thewei!ht o $articles dissol*ed in the urine" +ubularsecretion is the mo*ement o a substance rom thekidney tubule into the blood in the $eritubular ca$illariesor *asa recta"

+he client $resents with nausea and *omitin!2 absentbowel sounds2 and colicky 1ank $ain" +he nurseinter$rets these )ndin!s as consistent with.a& Urethritisb& Ureteral colicc& Interstitial cystitisd& Acute $rostatitis:& Ureteral colic

A client is admitted with nausea2 *omitin!2 anddiarrhea" ?is blood $ressure on admission is @/4B mm?!" +he client is oli!uric and his blood urea nitro!en;:UN& and creatinine le*els are ele*ated" +he$hysician will most likely write an order or whichtreatment%a& tart I"" 1uids with a normal saline solution bolusollowed by a maintenance dose"b& Administer urosemide ;Lasi-& 3B m! I""c& Encoura!e oral 1uids"d& tart hemodialysis ater a tem$orary access isobtained"A& tart I 1uids with normal saline solution bolusollowed by a maintenance dose"E-$lanation. +he client is in $rerenal ailure caused byhy$o*olemia" I"" 1uids should be !i*en with a bolus onormal saline solution ollowed by maintenance I""thera$y" +his treatment should rehydrate the client2causin! his blood $ressure to rise2 his urine out$ut toincrease2 and the :UN and creatinine le*els tonormalie" +he client wouldn5t be able to tolerate oral1uids because o the nausea2 *omitin!2 and diarrhea"

+he client isn5t 1uid9o*erloaded so his urine out$ut won5tincrease with urosemide2 which would actually worsenthe client5s condition" +he client doesn5t re0uire dialysisbecause the oli!uria and ele*ated :UN and creatininele*els are caused by dehydration"

#hich o the ollowin! would the nurse e-$ect to )ndwhen re*iewin! the laboratory test results o a clientwith renal ailure%a& Increased red blood cell countb& Decreased serum $otassium le*el

c& Increased serum calcium le*eld& Increased serum creatinine le*el


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D& Increased serum creatinine le*elE-$lanation. In renal ailure2 laboratory blood testsre*eal ele*ations in :UN2 creatinine2 $otassium2ma!nesium2 and $hos$horus" Calcium le*els are low"

+he R:C count2 hematocrit2 and hemo!lobin are

decreased"A nurse assesses a client shortly ater li*in! donorkidney trans$lant sur!ery" #hich $osto$erati*e )ndin!must the nurse re$ort to the $hysician immediately%a& erum sodium le*el o 647 mE0/Lb& erum $otassium le*el o " mE0/Lc& +em$erature o "3 F ;4@"4 C&d& Urine out$ut o 3B ml/hourD& Urine out$ut o 3B ml/hourE-$lanation. :ecause kidney trans$lantation carries the

risk o trans$lant reGection2 inection2 and other seriouscom$lications2 the nurse should monitor the client5surinary unction closely" A decrease rom the normalurine out$ut o 4B ml/hour is si!ni)cant and warrantsimmediate $hysician noti)cation" A serum $otassiumle*el o " mE0/L2 a serum sodium le*el o 647 mE0/L2and a tem$erature o "3 F are normal assessment)ndin!s"

A nurse is re*iewin! the history and $hysicale-amination o a client with a sus$ected mali!nanttumor o the bladder" #hich )ndin! would the nurseidentiy as the most common initial sym$tom%a& Urinary retentionb& 8ainless hematuriac& Fe*erd& Fre0uencyA& 8ainless hematuriaE-$lanation. +he most common )rst sym$tom o amali!nant tumor o the bladder is $ainless hematuria"Additional early sym$toms include U+I with sym$tomssuch as e*er2 dysuria2 ur!ency2 and re0uency" Latersym$toms are related to metastases and include $el*ic$ain2 urinary retention ;i the tumor blocks the bladderoutlet&2 and urinary re0uency rom the tumor occu$yin!bladder s$ace"

Ater teachin! a !rou$ o students about how to$erorm $eritoneal dialysis2 which statement wouldindicate to the instructor that the students needadditional teachin!%a& '+he eHuent should be allowed to drain by !ra*ity"'

b& 'It is im$ortant to use strict ase$tic techni0ue"'c& '+he inusion clam$ should be o$en durin!


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inusion"'d& 'It is a$$ro$riate to warm the dialysate in amicrowa*e"'D& It is a$$ro$riate to warm the dialysate in amicrowa*e

E-$lanation. +he dialysate should be warmed in acommercial warmer and ne*er in a microwa*e o*en"trict ase$tic techni0ue is essential" +he inusion clam$is o$ened durin! the inusion and clam$ed ater theinusion" #hen the dwell time is done2 the drain clam$ iso$ened and the 1uid is allowed to drain by !ra*ity intothe draina!e ba!"

#hich o the ollowin! is a characteristic o a normalstoma%a& 8ainul

b& No bleedin! when cleansin! stomac& Dry in a$$earanced& 8ink colorD& 8ink colorE-$lanation. Characteristics o a normal stoma include a$ink and moist a$$earance" It is insensiti*e to $ainbecause it has no ner*e endin!s" +he area is *ascularand may bleed when cleaned"

+o assess circulatin! o-y!en le*els2 the 3BB6 idneyDisease Jutcomes Kuality Initiati*e. (ana!ement oAnemia >uidelines recommends the use o which othe ollowin! dia!nostic tests%a& ?emo!lobinb& ?ematocritc& Arterial blood !asesd& erum iron le*elsA& ?emo!lobinE-$lanation. Althou!h hematocrit has always been theblood test o choice to assess or anemia2 the 3BB6idney Disease Jutcomes Kuality Initiati*e.(ana!ement o Anemia >uidelines2 recommend thatanemia be 0uanti)ed usin! hemo!lobin rather thanhematocrit measurements" ?emo!lobin isrecommended as it is more accurate in the assessmento circulatin! o-y!en than hematocrit" erum iron le*elsmeasure iron stora!e in the body" Arterial blood !asesassess the ade0uacy o o-y!enation2 *entilation2 andacid9base status"

A nurse is re*iewin! the history o a client who issus$ected o ha*in! !lomerulone$hritis" #hich o the

ollowin! would the nurse consider si!ni)cant%a& ?istory o hy$er$arathyroidism


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b& ?istory o osteo$orosisc& Recent history o stre$tococcal inectiond& 8re*ious e$isode o acute $yelone$hritisC& Recent h- o stre$tococcal inectionE-$lanation. >lomerulone$hritis can occur as a result o

inections rom !rou$ A beta9hemolytic stre$tococcalinections2 bacterial endocarditis2 or *iral inections suchas he$atitis : or C or human immunode)ciency *irus;?I&" A history o hy$er$arathyroidism or osteo$orosiswould $lace the client at risk or de*elo$in! renalcalculi" A history o $yelone$hritis would increase theclient5s risk or chronic $yelone$hritis"

A client $resents at the testin! center or anintra*enous $yelo!ram" #hat 0uestion should thenurse ask to ensure the saety o the client%

a& '?a*e you any arti)cial Goints%'b& 'Do you ha*e a $acemaker%'c& 'Do you ha*e any aller!ies%'d& '#ho has come with you today%'C& Do you ha*e any aller!ies%E-$lanation. (any contrast dyes contain iodine"

+hereore2 it is essential or the nurse to determinewhether the client has any aller!ies2 es$ecially to iodine2shell)sh2 and other seaood"

#hich ty$e o incontinency reers to the in*oluntaryloss o urine due to medications%a& J*er1owb& Ur!ec& Re1e-d& Iatro!enicD& Iatro!enicE-$lanation. Iatro!enic incontinence is the in*oluntaryloss o urine due to medications" Re1e- incontinence isthe in*oluntary loss o urine due to hy$erre1e-ia in theabsence o normal sensations usually associated with*oidin!" Ur!e incontinence is the in*oluntary loss ourine associated with a stron! ur!e to *oid that cannotbe su$$ressed" J*er1ow incontinence is the in*oluntaryloss o urine associated with o*erdistention o thebladder"

+he nurse is to check residual urine amounts or aclient e-$eriencin! urinary retention" #hich o theollowin! would be most im$ortant%a& Catheterie the client immediately ater the client*oids"

b& Check or residual ater the client re$orts the ur!eto *oid"


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c& et u$ a routine schedule o e*ery hours to checkor residual urine"d& Record the *olume o urine obtained"A& Catheterie the client immediately ater the client*oids

E-$lanation. +o obtain accurate residual *olumes2 it isim$ortant that clients *oid )rst and that catheteriationoccur immediately ater the attem$t" +he nurse shouldrecord both the *olume *oided ;e*en i it is ero& andthe *olume obtained by catheteriation" Intermittentcatheteriations are $erormed based on a schedule2usually 4 to times $er day" Residual urine reers to theamount remainin! in the bladder ater *oidin!" It isessential that the client *oids"

+he client asks the nurse about the unctions o the

kidney" #hich should the nurse include whenres$ondin! to the client% elect all that a$$ly"a& itamin D synthesisb& ecretion o $rosta!landinsc& itamin : $roductiond& ecretion o insuline& Re!ulation o blood $ressureA& itamin D synthesis:& ecretion o $rosta!landinsE& Re!ulation o blood $ressureE-$lanation. Functions o the kidney include secretion o

$rosta!landins2 re!ulation o blood $ressure2 andsynthesis o aldosterone and *itamin D" +he $ancreassecretes insulin" +he body does not $roduce itamin :"

A client is scheduled or a creatinine clearance test"

+he nurse should e-$lain that this test is done toassess the kidneys5 ability to remo*e a substance romthe $lasma in.a& 6 hour"b& 3 hours"c& 6 minute"d& 4B minutes"C& 6 minuteE-$lanation. +he creatinine clearance test determinesthe kidneys5 ability to remo*e a substance rom the$lasma in 6 minute" It doesn5t measure the kidneys5ability to remo*e a substance o*er a lon!er $eriod"

A client with renal ailure is under!oin! continuousambulatory $eritoneal dialysis" #hich nursin!dia!nosis is the most a$$ro$riate or this client%

a& Im$aired urinary eliminationb& +oiletin! sel9care de)cit


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c& Risk or inectiond& Acti*ity intoleranceC& Risk or inectionE-$lanation. +he $eritoneal dialysis catheter and re!ulare-chan!es o the dialysis ba! $ro*ide a direct $ortal or

bacteria to enter the body" I the client e-$eriencesre$eated $eritoneal inections2 continuous ambulatory$eritoneal dialysis may no lon!er be e,ecti*e in clearin!waste $roducts" Im$aired urinary elimination2 +oiletin!sel9care de)cit2 and Acti*ity intolerance may be$ertinent but are secondary to the risk o inection"

#hen $re$arin! a client or hemodialysis2 which o theollowin! would be most im$ortant or the nurse to do%a& Check or thrill or bruit o*er the access site"b& #arm the solution to body tem$erature"

c& Ins$ect the catheter insertion site or inection"d& Add the $rescribed dru! to the dialysate"A& Check or thrill or bruit o*er the access site" #hen$re$arin! a client or hemodialysis2 the nurse wouldneed to check or a thrill or bruit o*er the *ascularaccess site to ensure $atency" Ins$ectin! the catheterinsertion site or inection2 addin! the $rescribed dru! tothe dialysate2 and warmin! the solution to bodytem$erature would be necessary when $re$arin! aclient or $eritoneal dialysis"

A $hysician orders cystosco$y and random bio$sies othe bladder or a client who re$orts $ainlesshematuria" +est results re*eal carcinoma in situ inse*eral bladder re!ions" +o treat bladder cancer2 theclient will ha*e a series o intra*esical instillations obacillus Calmette9>urin ;:C>&2 administered 6 weeka$art" #hen teachin! the client about :C>2 the nurseshould mention that this dru! commonly causes.a& delayed eGaculation"b& hematuria"c& im$otence"d& renal calculi":& hematuriaIntra*esical instillation o :C> commonly causeshematuria" Jther common ad*erse e,ects o :C>include urinary re0uency and dysuria" Less commonly2:C> causes cystitis2 urinary ur!ency2 urinaryincontinence2 urinary tract inection2 abdominal cram$sor $ain2 decreased bladder ca$acity2 tissue in urine2local inection2 renal to-icity2 and !enital $ain" :C> isn5tassociated with renal calculi2 delayed eGaculation2 orim$otence"


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A client under!oes e-tracor$oreal shock wa*elithotri$sy" :eore dischar!e2 the nurse should $ro*idewhich instruction%a& ':e aware that your urine will be cherry9red or 7 to@ days"'

b& 'Increase your 1uid intake to 3 to 4 L $er day"'c& 'A$$ly an antibacterial dressin! to the incisiondaily"'d& '+ake your tem$erature e*ery hours"':& Increase your 1uid intake to 3 to 4 L $er day

+he nurse should instruct the client to increase his 1uidintake" Increasin! 1uid intake 1ushes the renal calculira!ments throu!h < and $re*ents obstruction o < theurinary system" (easurin! tem$erature e*ery hoursisn5t needed" Lithotri$sy doesn5t re0uire an incision"?ematuria may occur or a ew hours ater lithotri$sy

but should then disa$$ear"A client de*elo$s decreased renal unction andre0uires a chan!e in antibiotic dosa!e" Jn which actorshould the $hysician base the dosa!e chan!e%a& +hera$eutic inde-b& >I absor$tion ratec& Li*er unction studiesd& Creatinine clearanceD& Creatinine clearance

+he $hysician should base chan!es to antibiotic dosa!es

on creatinine clearance test results2 which !au!e thekidney5s !lomerular )ltration rate= this actor isim$ortant because most dru!s are e-creted at least$artially by the kidneys" +he >I absor$tion rate2thera$eutic inde-2 and li*er unction studies don5t hel$determine dosa!e chan!e in a client with decreasedrenal unction"

A history o inection s$eci)cally caused by !rou$ Abeta9hemolytic stre$tococci is associated with which othe ollowin! disorders%a& Acute !lomerulone$hritisb& Acute renal ailurec& Ne$hrotic syndromed& Chronic renal ailureA& Acute !lomerulone$hritisAcute !lomerulone$hritis is also associated with*aricella oster *irus2 he$atitis :2 and E$stein9:arr *irus"Acute renal ailure is associated with hy$o$erusion tothe kidney2 $arenchymal dama!e to the !lomeruli ortubules2 and obstruction at a $oint distal to the kidney"Chronic renal ailure may be caused by systemic

disease2 hereditary lesions2 medications2 to-ic a!ents2inections2 and medications" Ne$hrotic syndrome is


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caused by disorders such as chronic !lomerulone$hritis2systemic lu$us erythematosus2 multi$le myeloma2 andrenal *ein thrombosis"

+he nurse is carin! or the client ollowin! sur!ery or

a urinary di*ersion" +he client reuses to look at thestoma or $artici$ate in its care" +he nurse ormulates anursin! dia!nosis o.

a& Disturbed body ima!eb& ituational low sel esteemc& Antici$atory !rie*in!d& De)cient knowled!e. stoma careA& Disturbed body ima!e

+he client is e-hibitin! de)nin! characteristics odisturbed body ima!e"

A client admitted with a !unshot wound to theabdomen is transerred to the intensi*e care unit ateran e-$loratory la$arotomy" I"" 1uid is bein! inused at67B ml/hour" #hich assessment )ndin! su!!ests thatthe client is e-$eriencin! acute renal ailure ;ARF&%a& Urine out$ut o 37B ml/3 hoursb& +em$erature o 6BB"3 F ;4@"M C&c& erum creatinine le*el o 6"3 m!/dld& :lood urea nitro!en ;:UN& le*el o 33 m!/dlA& Urine out$ut o 37B ml/3 hoursARF2 characteried by abru$t loss o kidney unction2commonly causes oli!uria2 which is characteried by aurine out$ut o 37B ml/3 hours" A serum creatininele*el o 6"3 m!/dl isn5t dia!nostic o ARF" A :UN le*el o33 m!/dl or a tem$erature o 6BB"3 F ;4@"M C& wouldn5tresult rom this disorder"

A nurse is re*iewin! the laboratory test results o aclient with renal disease" #hich o the ollowin! wouldthe nurse e-$ect to )nd%

a& Decreased blood urea nitro!en ;:UN&b& Decreased $otassiumc& Increased serum albumind& Increased serum creatinineD& Increased serum creatinineIn clients with renal disease2 the serum creatinine le*elwould be increased" +he :UN also would be increased2serum albumin would be decreased2 and $otassiumwould likely be increased"

#hich ty$e o medication may be used in the

treatment o a $atient with incontinence to inhibitcontraction o the bladder%


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a& Anticholiner!ic a!entb& J*er9the9counter decon!estantc& +ricyclic antide$ressantsd& Estro!en hormoneA& Anticholiner!ic a!ent

Anticholiner!ic a!ents are considered )rst9linemedications or ur!e incontinence" Estro!en decreasesobstruction to urine 1ow by restorin! the mucosal2*ascular2 and muscular inte!rity o the urethra" +ricyclicantide$ressants decrease bladder contractions as wellas increase bladder neck resistance" tress incontinencemay be treated usin! $seudoe$hedrine and$henyl$ro$anolamine2 in!redients ound in o*er9the9counter decon!estants"

Retention o which electrolyte is the most lie9

threatenin! e,ect o renal ailure%a& 8otassiumb& Calciumc& 8hos$horousd& odiumA& 8otassiumRetention o $otassium is the most lie9threatenin!e,ect o renal ailure"

Ater teachin! a !rou$ o students about the ty$es ourinary incontinence and $ossible causes2 theinstructor determines that the student ha*eunderstood the material when they identiy which othe ollowin! as a cause o stress incontinence%a& Jbstruction due to ecal im$action or enlar!ed$rostateb& :ladder irritation related to urinary tract inectionsc& Increased urine $roduction due to metabolicconditionsd& Decreased $el*ic muscle tone due to multi$le$re!nanciesD& Decreased $el*ic muscle tone due to multi$le$re!nanciestress incontinence is due to decreased $el*ic muscletone2 which is associated with multi$le $re!nancies2obstetric inGuries2 obesity2 meno$ause2 or $el*ic disease"

+ransient incontinence is due to increased urine$roduction related to metabolic conditions" Ur!eincontinence is due to bladder irritation related tourinary tract inections2 bladder tumors2 radiationthera$y2 enlar!ed $rostate2 or neurolo!ic dysunction"J*er1ow incontinence is due to obstruction rom ecalim$action or enlar!ed $rostate"


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Ater under!oin! retro$ubic $rostatectomy2 a clientreturns to his room" +he client is on nothin!9by9mouthstatus and has an I"" inusin! in his ri!ht orearm at arate o 6BB ml/hour" +he client also has an indwellin!urinary catheter that5s drainin! li!ht $ink urine" #hile

assessin! the client2 the nurse notes that his urineout$ut is red and has dro$$ed to 67 ml and 6B ml orthe last 3 consecuti*e hours" ?ow can the nurse beste-$lain this dro$ in urine out$ut%a& It5s an abnormal )ndin! that re0uires urtherassessment"b& It5s a normal )ndin! caused by blood loss durin!sur!ery"c& It5s an abnormal )ndin! that will correct itsel whenthe client ambulates"d& It5s a normal )ndin! associated with the client5s

nothin!9by9mouth status"A& It5s an abornmal )ndin! that re0uires urtherassessment"

+he dro$ in urine out$ut to less than 4B ml/hour isabnormal and re0uires urther assessment" +hereduction in urine out$ut may be caused by anobstruction in the urinary catheter tubin! or de)cient1uid *olume rom blood loss" +he client5s nothin!9by9mouth status isn5t the cause o the low urine out$utbecause the client is recei*in! I"" 1uid to com$ensateor the lack o oral intake" Ambulation $romotes

urination= howe*er2 the client should $roduce at least 4Bml o urine/hour"

+he nurse is carin! or a client who is scheduled orthe creation o an ileal conduit" #hich statement bythe client $ro*ides e*idence that client teachin! wase,ecti*e%a& '(y urine will be eliminated with my eces"'b& 'A catheter will drain urine directly rom my kidney"'c& 'I will not need to worry about bein! incontinent ourine"'

d& '(y urine will be eliminated throu!h a stoma"'D& (y urine will be eliminated throu!h a stomaAn ileal conduit is a non9continent urinary di*ersionwhereby the ureters drain into an isolated section oileum" A stoma is created at one end o the ileum2e-itin! throu!h the abdominal wall"

Nursin! mana!ement o the client with a urinary tractinection should include.a& +eachin! the client to douche dailyb& Discoura!in! ca,eine intake

c& Administerin! mor$hine sulated& Instructin! the client to limit 1uid intake


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:& Discoura!in! ca,eine intaketrate!ies or $re*entin! urinary tract inection include$ro$er $erineal hy!iene2 increased 1uid intake2 a*oidin!urinary tract irritants ;includin! ca,eine&2 andestablishin! a re0uent *oidin! re!imen"

+he most common $resentin! obGecti*e sym$toms o aurinary tract inection in older adults2 es$ecially inthose with dementia2 include%a& ?ematuriab& Chan!e in co!niti*e unctionin!c& :ack $aind& Incontinence:& Chan!e in co!niti*e unctionin!

+he most common obGecti*e )ndin! is a chan!e inco!niti*e unctionin!2 es$ecially in those with dementia2

because these $atients usually e-hibit e*en more$roound co!niti*e chan!es with the onset o a U+I"Incontinence2 hematuria2 and back $ain are not the mostcommon $resentin! obGecti*e sym$toms"

#hich o the ollowin! would be included in a teachin!$lan or a $atient dia!nosed with a urinary tractinection%a& Drink co,ee or tea to increase diuresisb& Use tub baths as o$$osed to showersc& oid e*ery to hoursd& Drink liberal amount o 1uidsD& Drink liberal amounts o 1uids8atients dia!nosed with a U+I should drink liberalamounts o 1uids" +hey should *oid e*ery 3 to 4 hours"Co,ee and tea are urinary irritants" +he $atient shouldshower instead o bathe in a tub because bacteria in thebath water may enter the urethra"

+he ollowin! catheteriation $rocedures are used totreat clients with urinary retention" #hich $rocedure

would the nurse identiy as carryin! the !reatest riskto the client%a& Clean intermittent catheteriationb& u$ra$ubic cystostomy tubec& 8ermanent draina!e with a urethral catheterd& Cred *oidin! $rocedureC& 8ermanent draina!e with a urethral catheter8ermanent draina!e with a urethral catheter carries the!reatest risk" It may also increase the risk or bladderstones2 renal diseases2 bladder inections2 and urose$sis2a se*ere systemic inection by microor!anisms in the

urinary tract in*adin! the bloodstream" Cleanintermittent catheteriation has the ewest


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com$lications and is the $reerred treatment or urinaryretention" +he Cred *oidin! $rocedure is used in thecase o clients who ha*e lost control o*er their ner*oussystems2 secondary to inGury or disease"

A client with urinary tract inection is $rescribed$henao$yridine ;8yridium&" #hich o the ollowin!instructions would the nurse !i*e the client%a& '+his medication will $re*ent re9inection"'b& '+his medication should be taken at bedtime"'c& '+his medication will relie*e your $ain"'d& '+his will kill the or!anism causin! the inection"'C& +his medication will relie*e your $ain8henao$yridine ;8yridium& is a urinary anal!esic a!entused or the treatment o burnin! and $ain associatedwith U+Is"

A nurse has been asked to s$eak to a local women5s!rou$ about $re*entin! cystitis" #hich o the ollowin!would the nurse include in the $resentation%a& Need to urinate ater en!a!in! in se-ual intercourseb& Need to wear underwear made rom syntheticmaterialc& Im$ortance o urinatin! e*ery to hours whileawaked& u!!estion to take tub baths instead o showersA& Need to urinate ater en!a!in! in se-ual intercourse(easures to $re*ent cystitis include *oidin! ater se-ualintercourse2 wearin! cotton underwear2 urinatin! e*ery3 to 4 hours while awake2 and takin! showers instead otub baths"

#hich o the ollowin! is a actor contributin! to U+I inolder adults%a& Low incidence o chronic illnessb& $oradic use o antimicrobial a!entsc& Immunocom$romise

d& Acti*e liestyleC& Immunocom$romiseFactors that contribute to urinary tract inection in olderadults include immunocom$romise2 hi!h incidence ochronic illness2 immobility2 and re0uent use oantimicrobial a!ents"

Oou are carin! or a @39year9old client who has beenadmitted to your unit or a 1uid *olume imbalance" Oouknow which o the ollowin! is the most common 1uidimbalance in older adults%

a& ?y$o*olemiab& Dehydration


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c& ?y$er*olemiad& Fluid *olume e-cess:& Dehydration

+he most common 1uid imbalance in older adults isdehydration" :ecause o reduced thirst sensation that

oten accom$anies a!in!2 older adults tend to drink lesswater" Use o diuretic medications2 la-ati*es2 or enemasmay also de$lete 1uid *olume in older adults" Chronic1uid *olume de)cit can lead to other $roblems such aselectrolyte imbalances" +hereore2 o$tions A2 C2 and Dare incorrect"

+o e*aluate a client or hy$o-ia2 the $hysician is mostlikely to order which laboratory test%a& Red blood cell countb& $utum culture

c& +otal hemo!lobind& Arterial blood !as ;A:>& analysisD& A:>sRed blood cell count2 s$utum culture2 total hemo!lobin2and A:> analysis all hel$ e*aluate a client withres$iratory $roblems" ?owe*er2 A:> analysis is the onlytest that e*aluates !as e-chan!e in the lun!s2 $ro*idin!inormation about the client5s o-y!enation status"

#hich o the ollowin! would be a $otential cause ores$iratory acidosis%a& omitin!b& ?y$er*entilationc& Diarrhead& ?y$o*entilationD& ?y$o*entilationRes$iratory acidosis is always due to inade0uatee-cretion o CJ2 with inade0uate *entilation2 resultin! inele*ated $lasma CJ concentration2 which causesincreased le*els o carbonic acid" In addition to anele*ated 8aCJ2 hy$o*entilation usually causes adecrease in 8aJ"

#hich o the ollowin! is the most common cause osym$tomatic hy$oma!nesemia%a& Alcoholismb& I dru! usec& edentary liestyled& :urnsA& AlcoholismAlcoholism is currently the most common cause osym$tomatic hy$oma!nesemia" I dru! use2 sedentary

liestyle2 and burns are not the most common causes ohy$oma!nesemia"


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#hen e*aluatin! arterial blood !ases ;A:>s&2 which*alue is consistent with metabolic alkalosis%a& 8aCJ 4b& ?CJ 36 mE0/L

c& J saturation 7Pd& $? @"MA& 8aCJ 4(etabolic alkalosis is a clinical disturbancecharacteried by a hi!h $? and hi!h $lasma bicarbonateconcentration" +he ?CJ *alue is below normal" +he8aCJ *alue and the o-y!en saturation le*el are within anormal ran!e

#hich o the ollowin! is a correct route oadministration or $otassium%a& I ;intra*enous& $ushb& Jralc& Intramusculard& ubcutaneous:& Jral8otassium may be administered throu!h the oral route"8otassium is ne*er administered by I $ush orintramuscularly to a*oid re$lacin! $otassium too 0uickly"8otassium is not administered subcutaneously"

A nurse re*iews the arterial blood !as ;A:>& *alues oa client admitted with $neumonia. $?2 @"76= 8aCJ32 3Mmm ?!= 8aJ32 @B mm ?!= and ?CJ4992 3 mE0/L"#hat do these *alues indicate%a& (etabolic alkalosisb& (etabolic acidosisc& Res$iratory alkalosisd& Res$iratory acidosisC& Res$iratory AlkalosisA client with $neumonia may hy$er*entilate in an e,ortto increase o-y!en intake" ?y$er*entilation leads to

e-cess carbon dio-ide ;CJ3& loss2 which causes alkalosis< indicated by this client5s ele*ated $? *alue" #ithres$iratory alkalosis2 the kidneys5 bicarbonate ;?CJ49&res$onse is delayed2 so the client5s ?CJ49 le*el remainsnormal" +he below9normal *alue or the $artial $ressureo arterial carbon dio-ide ;8aCJ3& indicates CJ3 lossand si!nals a res$iratory com$onent" :ecause the?CJ49 le*el is normal2 this imbalance has no metaboliccom$onent" +hereore2 the client is e-$eriencin!res$iratory alkalosis"

Oou are carin! or a client with se*ere hy$okalemia"+he $hysician has ordered I $otassium to be


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administered at 6B mE0/hr" +he client com$lains oburnin! alon! their *ein" #hat should you do%a& Chan!e the electrolyte"b& witch to an oral ormulation"c& Increase the s$eed o transusion"

d& Dilute the inusion"D& Dilute the inusion+reatment o se*ere hy$okalemia re0uires treatmentwith I inusion o $otassium" Clients may e-$erienceburnin! alon! the *ein with I inusion o $otassium in$ro$ortion to the inusion5s concentration" I the clientcan tolerate the 1uid2 consult with the $hysician aboutdilutin! the $otassium in a lar!er *olume o I solution"Jral $otassium may not be enou!h in se*ere caseshy$okalemia" ?y$okalemia re0uires treatment with$otassium and not any other electrolyte"

:elow which serum sodium le*el may con*ulsions orcoma can occur%a& 6B mE0/Lb& 647 mE0/Lc& 63 mE0/Ld& 67 mE0/L:& 647 mE0/LNormal serum concentration le*el ran!es rom 647 to67 mE0/L" #hen the le*el di$s below 647 mE0/L2 thereis hy$onatremia" (aniestations o hy$onatremia include

mental conusion2 muscular weakness2 anore-ia2restlessness2 ele*ated body tem$erature2 tachycardia2nausea2 *omitin!2 and $ersonality chan!es" Con*ulsionsor coma can occur i the de)cit is se*ere" alues o 6B2632 and 67 mE0/L are within the normal ran!e"

+he calcium le*el o the blood is re!ulated by whichmechanism%a& Andro!ensb& Adrenal !landc& 8arathyroid hormone ;8+?&d& +hyroid hormone ;+?&C& 8+?

+he serum calcium le*el is controlled by 8+? andcalcitonin" +he thyroid hormone2 adrenal !land2 orandro!ens do not re!ulate the calcium le*el in theblood"

Russell +hom$kins2 a @@9year9old retired male2 *isitsyour !eneral $ractice oQce twice monthly to maintaincontrol o his con!esti*e heart ailure" ?e measures his

wei!ht daily and $hones it to your oQce or hismedical record" In a 39hour $eriod2 how much 1uid is


18/35

Russell retainin! i his wei!ht increases by two$ounds%a& Jne literb& 637B mlc& 67BB ml

d& 7BB mlA& Jne literA 39lb wei!ht !ain in 3 hours indicates that the client isretainin! 6L o 1uid"

A client has the ollowin! arterial blood !as ;A:>&*alues. $?2 @"63= $artial $ressure o arterial carbondio-ide ;8aCJ3&2 B mm ?!= and bicarbonate ;?CJ49&267 mE0/L" +hese A:> *alues su!!est which disorder%a& (etabolic alkalosisb& (etabolic acidosis

c& Res$iratory acidosisd& Res$iratory alkalosis:& (etabolic acidosis

+his client5s $? *alue is below normal2 indicatin!acidosis" +he ?CJ49 *alue also is below normal2re1ectin! an o*erwhelmin! accumulation o acids ore-cessi*e loss o base2 which su!!ests metabolicacidosis" +he 8aCJ3 *alue is normal2 indicatin! absenceo res$iratory com$ensation" +hese A:> *alueseliminate res$iratory alkalosis2 res$iratory acidosis2 andmetabolic alkalosis"

+o com$ensate or decreased 1uid *olume;hy$o*olemia&2 the nurse can antici$ate whichres$onse by the body%a& :radycardiab& +achycardiac& Increased urine out$utd& asodilation:& +achycardiaFluid *olume de)cit2 or hy$o*olemia2 occurs when theloss o e-tracellular 1uid e-ceeds the intake o 1uid"Clinical si!ns include oli!uia2 ra$id heart rate2*asoconstriction2 cool and clammy skin2 and muscleweakness" +he nurse monitors or ra$id2 weak $ulse andorthostatic hy$otension"

A client comes to the emer!ency de$artment withstatus asthmaticus" ?is res$iratory rate is Mbreaths/minute2 and he is wheein!" An arterial blood!as analysis re*eals a $? o @"732 a $artial $ressure oarterial carbon dio-ide ;8aCJ3& o 4B mm ?!2 8aJ3 o

@B mm ?!2 and bicarbonate ;?CJ4%%5& o 3 mE0/L"#hat disorder is indicated by these )ndin!s%


19/35

a& (etabolic acidosisb& Res$iratory alkalosisc& (etabolic alkalosisd& Res$iratory acidosis:& Res$iratory Alkalosis

Res$iratory alkalosis results rom al*eolarhy$er*entilation" It5s marked by a decrease in 8aCJ3 toless than 47 mm ?! and an increase in blood $? o*er@"7" (etabolic acidosis is marked by a decrease in?CJ4% to less than 33 mE0/L2 and a decrease in blood$? to less than @"47" In res$iratory acidosis2 the $? isless than @"47 and the 8aCJ3 is !reater than 7 mm ?!"In metabolic alkalosis2 the ?CJ4% is !reater than 3mE0/L and the $? is !reater than @"7"

A client hos$italied or treatment o a $ulmonary

embolism de*elo$s res$iratory alkalosis" #hich clinical)ndin!s commonly accom$any res$iratory alkalosis%a& Nausea or *omitin!b& ?allucinations or tinnitusc& Li!ht9headedness or $aresthesiad& Abdominal $ain or diarrheaC& Li!ht9headedness or $aresthesia

+he client with res$iratory alkalosis may com$lain oli!ht9headedness or $aresthesia ;numbness and tin!lin!in the arms and le!s&" Nausea2 *omitin!2 abdominal$ain2 and diarrhea may accom$any res$iratory acidosis"

?allucinations and tinnitus rarely are associated withres$iratory alkalosis or any other acid9base imbalance"

+he normal serum *alue or $otassium isa& to 6B mE0/L"b& 647 to 67 mE0/L"c& 4"7 to 7"7 mE0/L"d& M"7 to 6B"7 m!/dL"C& 4"797"7 mE0/Lerum $otassium must be within normal limits to$re*ent cardiac dysrhythmia" Normal serum sodium is647 to 67 mE0/L" Normal serum chloride is to 6BmE0/L" Normal total serum calcium is M"7 to 6B

A client is takin! s$ironolactone ;Aldactone& to controlher hy$ertension" ?er serum $otassium le*el is mE0/L" For this client2 the nurse5s $riority should be toassess her.a& electrocardio!ram ;EC>& results"b& neuromuscular unction"c& bowel sounds"

d& res$iratory rate"


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A& EC> resultsAlthou!h chan!es in all these )ndin!s are seen inhy$erkalemia2 EC> results should take $riority becausechan!es can indicate $otentially lethal arrhythmias suchas *entricular )brillation" It wouldn5t be a$$ro$riate to

assess the client5s neuromuscular unction2 bowelsounds2 or res$iratory rate or e,ects o hy$erkalemia"

A $hysician orders re!ular insulin 6B units I"" alon!with 7B ml o de-trose 7BP or a client with acuterenal ailure" #hat electrolyte imbalance is this clientmost likely e-$eriencin!%a& ?y$er!lycemiab& ?y$ercalcemiac& ?y$erkalemiad& ?y$ernatremia

C& ?y$erkalemiaAdministerin! re!ular insulin I"" concomitantly with 7Bml o de-trose 7BP hel$s shit $otassium rom thee-tracellular 1uid into the cell2 which normalies serum$otassium le*els in the client with hy$erkalemia" +hiscombination doesn5t hel$ re*erse the e,ects ohy$ercalcemia2 hy$ernatremia2 or hy$er!lycemia"

A client in the emer!ency de$artment re$orts that hehas been *omitin! e-cessi*ely or the $ast 3 days" ?isarterial blood !as analysis shows a $? o @"7B2 $artial$ressure o arterial carbon dio-ide ;8aCJ3& o 4 mm?!2 $artial $ressure o arterial o-y!en ;8aJ3& o @7mm ?!2 and bicarbonate ;?CJ49& o 3 mE0/L" :asedon these )ndin!s2 the nurse documents that the clientis e-$eriencin! which ty$e o acid9base imbalance%a& Res$iratory acidosisb& Res$iratory alkalosisc& (etabolic alkalosisd& (etabolic acidosisC& (etabolic AlkalosisA $? o*er @"7 with a ?CJ49 le*el o*er 3 mE0/Lindicates metabolic alkalosis" (etabolic alkalosis isalways secondary to an underlyin! cause and is markedby decreased amounts o acid or increased amounts obase ?CJ49" +he client isn5t e-$eriencin! res$iratoryalkalosis because the 8aCJ3 is normal" +he client isn5te-$eriencin! res$iratory or metabolic acidosis becausethe $? is !reater than @"47"

8atients dia!nosed with hy$er*olemia should a*oidsweet or dry ood because.

a& It obstructs water elimination"b& It can cause dehydration"


21/35

c& It can lead to wei!ht !ain"d& It increases the client5s desire to consume 1uid"D& It increases the client5s desire to consume 1uid

+he mana!ement !oal in hy$er*olemia is to reduce 1uid*olume" For this reason2 1uid is rationed2 and the client

is ad*ised to take limited amount o 1uid when thirsty"weet or dry ood can increase the client5s desire toconsume 1uid" weet or dry ood does not obstructwater elimination nor does it cause dehydration" #ei!htre!ulation is not $art o hy$er*olemia mana!emente-ce$t to the e-tent that it is achie*ed on account o1uid reduction"

Oour client has a dia!nosis o hy$er*olemia" #hatwould be an im$ortant inter*ention that you wouldinitiate%

a& >i*e medications that $romote 1uid retention"b& Limit sodium and water intake"c& +each client beha*iors that decrease urination"d& Assess or dehydration":& Limit sodium and water intakeIm$lement $rescribed inter*entions such as limitin!sodium and water intake and administerin! orderedmedications that $romote 1uid elimination" Assessin!or dehydration and teachin! to decrease urinationwould not be a$$ro$riate inter*entions"

#hich o the ollowin! solutions is hy$otonic%a& B"7P NaClb& 7P NaClc& B"P NaCld& Lactated Rin!er5s solutionA& B"7P NaCl?al9stren!th saline is hy$otonic" Lactated Rin!er5ssolution is isotonic" Normal saline ;B"P NaCl& isisotonic" A solution that is 7P NaCl is hy$ertonic"

#hich o the ollowin! are the insensible mechanismso 1uid loss%a& :owel eliminationb& Urinationc& Nausead& :reathin!D& :reathin!Loss o 1uid rom sweat or dia$horesis is reerred to asinsensible loss because it is unnoticeable andimmeasurable" Losses rom urination and bowelelimination are measurable"


22/35

A !rou$ o nursin! students are studyin! or a testo*er acid9base imbalance" Jne student asks anotherwhat the maGor chemical re!ulator o $lasma $? is"#hat should the second student res$ond%a& Renin9an!iotensin9aldosterone system

b& :icarbonate9carbonic acid bu,er systemc& odium9$otassium $um$d& AD?9AN8 bu,er system:& :icarbonate9carbonic acid bu,er system

+he maGor chemical re!ulator o $lasma $? is thebicarbonate9carbonic acid bu,er system" +hereoreo$tions A and C are incorrect" J$tion D does not e-ist2 itis only a distractor or this 0uestion"

#hich o the ollowin! is considered an isotonicsolution%

a& 4P NaClb& B"P normal salinec& De-tran in Nd& B"7P normal saline:& B"P Normal alineAn isotonic solution is B"P normal saline ;NaCl&"De-tran in N is a colloid solution2 B"7P normal salineis a hy$otonic solution2 and 4P NaCl is a hy$ertonicsolution"

An elderly client takes B m! o Lasi- twice a day"#hich electrolyte imbalance is the most seriousad*erse e,ect o diuretic use%a& ?y$o$hos$hatemiab& ?y$ernatremiac& ?y$okalemiad& ?y$erkalemiaC& ?y$okalemia?y$okalemia ;$otassium le*el below 4"7 mE0/L& usuallyindicates a de)ct in total $otassium stores" 8otassium9losin! diuretics2 such as loo$ diuretics2 can inducehy$okalemia"

A client with >uillain9:arr syndrome de*elo$sres$iratory acidosis as a result o reduced al*eolar*entilation" #hich combination o arterial blood !as;A:>& *alues con)rms res$iratory acidosis%a& $?2 @"37= 8aCJ3 7B mm ?!b& $?2 @"47= 8aCJ3 B mm ?!c& $?2 @"B= 8aCJ3 47 mm ?!d& $?2 @"7= 8aCJ3 4B mm ?!:& oh2 @"37= 8aCJ3 7B mm ?!

In res$iratory acidosis2 A:> analysis re*eals an arterial$? below @"47 and $artial $ressure o arterial carbon


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dio-ide ;8aCJ3& abo*e 7 mm ?!" +hereore2 thecombination o a $? *alue o @"37 and a 8aCJ3 *alue o7B mm ?! con)rms res$iratory acidosis" A $? *alue o@"7 with a 8aCJ3 *alue o 4B mm ?! indicatesres$iratory alkalosis" A $h *alue o @"B with a 8aCJ3

*alue o 47 mm ?! and a $? *alue o @"47 with a 8aCJ3*alue o B mm ?! re$resent normal A:> *alues2re1ectin! normal !as e-chan!e in the lun!s"

A nurse correctly identi)es a urine s$ecimen with a $?o "4 as bein! which ty$e o solution%a& Alkalineb& Acidicc& :asicd& Neutral:& Acidic

Normal urine $? is "7 to M"B= a *alue o "4 re*ealsacidic urine $?" A $? abo*e @"B is considered an alkalineor basic solution" A $? o @"B is considered neutral"

A client has a serum calcium le*el o @"3 m!/dl" Durin!the $hysical e-amination2 the nurse e-$ects to assess.a& +rousseau5s si!n"b& ?e!ar5s si!n"c& ?omans5 si!n"d& >oodell5s si!n"A& +rossaeu5s si!n

+his client5s serum calcium le*el indicateshy$ocalcemia2 an electrolyte imbalance that causes

+rousseau5s si!n ;car$o$edal s$asm induced by in1atin!the blood $ressure cu, abo*e systolic $ressure&"?omans5 si!n ;$ain on dorsi1e-ion o the oot& indicatesdee$ *ein thrombosis" ?e!ar5s si!n ;sotenin! o theuterine isthmus& and >oodell5s si!n ;cer*ical sotenin!&are $robable si!ns o $re!nancy"

A nurse is carin! or a client with metastatic breast

cancer who is e-tremely lethar!ic and *ery slow tores$ond to stimuli" +he laboratory re$ort indicates aserum calcium le*el o 63"B m!/dl2 a serum $otassiumle*el o 4" mE0/L2 a serum chloride le*el o 6B6mE0/L2 and a serum sodium le*el o 6B mE0/L" :asedon this inormation2 the nurse determines that theclient5s sym$toms are most likely associated withwhich electrolyte imbalance%a& ?y$ocalcemiab& ?y$erkalemiac& ?y$okalemia

d& ?y$ercalcemia


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D& ?y$ercalcemia+he normal reerence ran!e or serum calcium is to 66m!/dl" A serum calcium le*el o 63 m!/dl clearlyindicates hy$ercalcemia" +he client5s other laboratory)ndin!s are within their normal ran!es2 so the client

doesn5t ha*e hy$ernatremia2 hy$ochloremia2 orhy$okalemia"

#hich o the ollowin! electrolytes is a maGor cation inbody 1uid%a& 8otassiumb& :icarbonatec& Chlorided& 8hos$hateA& 8otassium8otassium is a maGor cation that a,ects cardiac muscle

unctionin!" Chloride is an anion" :icarbonate is ananion" 8hos$hate is an anion"

#hich conditions lead to chronic res$iratory acidosis inolder adults%a& +horacic skeletal chan!eb& J*eruse o sodium bicarbonatec& Decreased renal unctiond& Erratic meal $atternsA& +horacic skeletal chan!e8oor res$iratory e-chan!e as the result o chronic lun!disease2 inacti*ity2 or thoracic skeletal chan!es maylead to chronic res$iratory acidosis" Decreased renalunction in older adults can cause an inability toconcentrate urine and is usually associated with 1uidand electrolyte imbalance" A $oor a$$etite2 erratic meal$atterns2 inability to $re$are nutritious meals2 or)nancial circumstances may in1uence nutritional status2resultin! in imbalances o electrolytes" J*eruse osodium bicarbonate may lead to metabolic alkalosis"

A client with a sus$ected o*erdose o an unknowndru! is admitted to the emer!ency de$artment"Arterial blood !as *alues indicate res$iratory acidosis"#hat should the nurse do )rst%a& 8re$are or !astric la*a!e"b& (onitor the client5s heart rhythm"c& Jbtain a urine s$ecimen or dru! screenin!"d& 8re$are to assist with *entilation"D& 8re$are to assist with *entilationRes$iratory acidosis is associated with hy$o*entilation=in this client2 hy$o*entilation su!!ests intake o a dru!

that has su$$ressed the brain5s res$iratory center"+hereore2 the nurse should assume the client has


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res$iratory de$ression and should $re$are to assist with*entilation" Ater the client5s res$iratory unction hasbeen stabilied2 the nurse can saely monitor the heartrhythm2 $re$are or !astric la*a!e2 and obtain a urines$ecimen or dru! screenin!"

A $riority nursin! inter*ention or a client withhy$er*olemia in*ol*es which o the ollowin!%a& (onitorin! res$iratory status or si!ns andsym$toms o $ulmonary com$lications"b& Establishin! I"" access with a lar!e9bore catheter"c& Encoura!in! the client to consume sodium9ree1uids"d& Drawin! a blood sam$le or ty$in! andcrossmatchin!"A& (onitorin! res$iratory status or si!ns ans sym$toms

o $ulmonary com$lications?y$er*olemia2 or 1uid *olume e-cess ;FE&2 reers to anisotonic e-$ansion o the e-tracellular 1uid" Nursin!inter*entions or FE include measurin! intake andout$ut2 monitorin! wei!ht2 assessin! breath sounds2monitorin! edema2 and $romotin! rest" +he mostim$ortant inter*ention in the list in*ol*es monitorin! theres$iratory status or any si!ns o $ulmonarycon!estion" :reath sounds are assessed at re!ularinter*als"

A 7@9year9old homeless emale with a history oalcohol abuse has been admitted to your hos$ital unit"he was admitted with si!ns and sym$toms ohy$o*olemia 9 minus the wei!ht loss" he e-hibits alocalied enlar!ement o her abdomen" #hat conditioncould she be $resentin!%a& ?y$o*olemiab& 8ittin! edemac& +hird9s$acin!d& AnasarcaC& +hird s$acin!

+hird9s$acin! describes the translocation o 1uid romthe intra*ascular or intercellular s$ace to tissuecom$artments2 where it becomes tra$$ed and useless"

+he client maniests si!ns and sym$toms ohy$o*olemia with the e-ce$tion o wei!ht loss" +heremay be si!ns o localied enlar!ement o or!an ca*ities;such as the abdomen& i they )ll with 1uid2 a conditionreerred to as ascites"

#hich set o arterial blood !as ;A:>& results re0uires

urther in*esti!ation%a& $? @"472 8aCJ3 B mm ?!2 8aJ3 6 mm ?!2 and


26/35

?CJ49 33 mE0/Lb& $? @"2 8aCJ3 4 mm ?!2 8aJ3 mm ?!2 and?CJ49 3 mE0/Lc& $? @"2 8aCJ3 4B mm ?!2 8aJ3 M mm ?!2 and?CJ49 6M mE0/L

d& $? @"4M2 $artial $ressure o arterial carbon dio-ide;8aCJ3& 4 mm ?!2 $artial $ressure o arterial o-y!en;8aJ3& 7 mm ?!2 bicarbonate ;?CJ49& 3 mE0/LC&$? @"2 8aCJ3 4B mm ?!2 8aJ3 M mm ?!2 and?CJ49 6M mE0/L+he A:> results $? @"2 8aCJ3 4B mm?!2 8aJ3 M mm ?!2 and ?CJ49 6M mE0/L indicateres$iratory alkalosis"

+he $? le*el is increased2 and the ?CJ49 and 8aCJ3le*els are decreased" Normal *alues are $? @"47 to @"7=8aCJ3 47 to 7 mm ?!= ?CJ49 33 to 3 mE0/L"

+he nurse is carin! or a client who is e-hibitin!sym$toms o tachy$nea and circumoral $aresthesias"#hat should be the nurse5s )rst course o action%a& to$ mechanical *entilation"b& Find and correct the cause o tachy$nea"c& Administer cardio$ulmonary resuscitation ;C8R&"d& >i*e a dose o as$irin":& Find and correct the cause o tachy$nea

+achy$nea or ra$id breathin! may result rom *ariousreasons includin! acute an-iety2 hi!h e*er2thyroto-icosis2 early salicylate $oisonin!2 hy$o-emia2 or

mechanical *entilation" +he ra$id breathin! e-$els moreCJ3 than necessary" +his causes a de)cit in carbonicacid2 leadin! to res$iratory alkalosis" Circumoral$aresthesia is one o the sym$toms" +he )rst course oaction is to detect and treat the cause o tachy$nea" +henurse has to maintain mechanical *entilation i the clientis de$endent on it" C8R administration is re0uired only ithe client5s condition needs it" As$irin is not ad*ised asearly as$irin $oisonin! may be a cause o thetachy$nea"

A 9year9old client is brou!ht in to the clinic withthirsty2 dry2 sticky mucous membranes2 decreasedurine out$ut2 e*er2 a rou!h ton!ue2 and lethar!y"erum sodium le*el is abo*e 67 mE0/L" hould thenurse start salt tablets when carin! or this client%a& No2 start with the sodium chloride I"b& No2 sodium intake should be restricted"c& Oes2 this will correct the sodium de)cit"d& Oes2 alon! with the hy$otonic I":& No2 sodium intake should be restricted

+he sym$toms and the hi!h le*el o serum sodium

su!!est hy$ernatremia2 ;e-cess o sodium&" It isnecessary to restrict sodium intake" alt tablets and


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sodium chloride I can only worsen this condition butmay be re0uired in hy$onatremia ;sodium de)cit&"?y$otonic solution I may be a $art o the treatment butnot alon! with the salt tablets"

A client with $ancreatic cancer has the ollowin! bloodchemistry $ro)le. >lucose2 astin!. 3B m!/dl= bloodurea nitro!en ;:UN&. 63 m!/dl= Creatinine. B" m!/dl=odium. 64 mE0/L= 8otassium. 3"3 mE0/L= Chloride. mE0/L= CJ3. 44 mE0/L" #hich result should thenurse identiy as critical and re$ort immediately%a& 8otassiumb& odiumc& Chlorided& CJ3A& 8otassium

+he nurse should identiy $otassium. 3"3 mE0/L ascritical because a normal $otassium le*el is 4"M to 7"7mE0/L" e*ere hy$okalemia can cause cardiac andres$iratory arrest2 $ossibly leadin! to death"?y$okalemia also de$resses the release o insulin andresults in !lucose intolerance" +he !lucose le*el is abo*enormal ;normal is @7 to 66B m!/dl& and the chloridele*el is a bit low ;normal is 6BB to 66B mE0/L&" Althou!hthese le*els should be re$orted2 neither is lie9threatenin!" +he :UN ;normal is M to 3 m!/dl& andcreatinine ;normal is B"M to 6" m!/dl& are within normal

ran!e"#hen a client5s *entilation is im$aired2 the bodyretains which substance%a& Carbon dio-ide ;CJ3&b& J-y!enc& odium bicarbonated& Nitrous o-ideA& Carbon dio-ide ;CJ3hen *entilation is im$aired2 the body retains CJ3because the carbonic acid le*el increases in the blood"odium bicarbonate is used to treat acidosis" Nitrouso-ide2 which has anal!esic and anesthetic $ro$erties2commonly is administered beore minor sur!ical$rocedures" #hen *entilation is im$aired2 the bodydoesn5t retain o-y!en" Instead2 the tissues use o-y!enand CJ3 results"

A !rou$ o students are re*iewin! inormation aboutdisorders o the bladder and urethra" +he studentsdemonstrate understandin! o the material when they

identiy which o the ollowin! as a *oidin!dysunction%


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a& Urinary retentionb& Cystitisc& :ladder stonesd& Urethral strictureA& Urinary retention

Urinary retention and urinary incontinence are *oidin!dysunctions2 tem$orary or $ermanent alterations in theability to urinate normally" Cystitis is an inectiousdisorder" :ladder stones and urethral stricture areobstructi*e disorders"

+he nurse e-$ects which o the ollowin! assessment)ndin!s in the client in the diuretic $hase o acuterenal ailure%a& Dehydrationb& Crackles

c& ?y$ertensiond& ?y$erkalemiaA& Dehydration

+he diuretic $hase o acute renal ailure is characteriedby increased urine out$ut2 hy$otension2 anddehydration"

A male client has doubts about $erormin! $eritonealdialysis at home" ?e inorms the nurse about hise-istin! u$$er res$iratory inection" #hich o theollowin! su!!estions can the nurse o,er to the clientwhile $erormin! an at9home $eritoneal dialysis%a& 8erorm dee$9breathin! e-ercises *i!orously"b& A*oid carryin! hea*y items"c& Auscultate the lun!s re0uently"d& #ear a mask when $erormin! e-chan!es"D& #ear a mask when $erormin! e-chan!es

+he nurse should ad*ise the client to wear a mask while$erormin! e-chan!es" +his $re*ents contamination othe dialysis catheter and tubin!2 and is usually ad*isedto clients with u$$er res$iratory inection" Auscultationo the lun!s will not $re*ent contamination o thecatheter or tubin!" +he client may also be ad*ised to$erorm dee$9breathin! e-ercises to $romote o$timallun! e-$ansion2 but this will not $re*ent contamination"Clients with a )stula or !rat in the arm should bead*ised a!ainst carryin! hea*y items"

#hich nursin! assessment )ndin! indicates that theclient who has under!one renal trans$lant has not mete-$ected outcomes%a& #ei!ht loss

b& Fe*er


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c& Absence o $aind& Diuresisb& Fe*erFe*er is an indicator o inection or trans$lant reGection"

A 439year9old 1i!ht attendant is under!oin!dia!nostics due to a si!ni)cant dro$ in renal out$ut"

+he $hysician has scheduled an an!io!ra$hy and youare in the midst o com$letin! client education aboutthe $rocedure" +he client asks what the an!io!ra$hywill re*eal" #hat is your res$onse2 as her nurse%a& Renal circulationb& Urine $roductionc& idney unctiond& idney structureA& Renal circulation

A renal an!io!ram ;renal arterio!ram& $ro*ides detailso the arterial su$$ly to the kidneys2 s$eci)cally thelocation and number o renal arteries ;multi$le *esselsto the kidney are not unusual& and the $atency o eachrenal artery"

+he nurse obser*es the color o the client5s urinewhich a$$ears $ale blue9!reen" +he nurse obtains adru! history rom the client based on theunderstandin! that dru!s used by the client may a,ectwhich o the ollowin!%a& ie o the urinary bladderb& Urinary tract testsc& Urine s$eci)c !ra*ityd& Amount o urine $roduced:& Urinary tract testsIt is im$ortant to in0uire about dru!s because somedru!s may a,ect the outcome o urinary tract tests aswell as the color and odor o the urine" Dietary intakemay a,ect urine characteristics as well as urinary tractdisorders and their mana!ement" Dru!s do not directlya,ect the sie o the urinary bladder or the amount ourine $roduced"

A nurse2 when carin! or a client2 notes that thes$eci)c !ra*ity o the client5s urine is low" #hat couldha*e lead to the low s$eci)c !ra*ity o urine%a& Re$eated diarrheab& E-cess 1uid intakec& Fre0uent *omitin!d& Urine retention:& E-cessi*e 1uid intake

E-cess 1uid intake results in low s$eci)c !ra*ity ourine" E-cessi*e 1uid intake will result in ormation o


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dilute urine" #hen the urine is diluted2 it results in lows$eci)c !ra*ity o urine" Fre0uent *omitin!2 re$eateddiarrhea2 and urine retention will result in hi!h s$eci)c!ra*ity o urine"

Followin! a unilateral adrenalectomy2 a nurse shouldassess or hy$erkalemia as indicated by.a& dia$horesis"b& tremors"c& muscle weakness"d& consti$ation"C& (uscle weakness(uscle weakness2 bradycardia2 nausea2 diarrhea2 and$aresthesia o the hands2 eet2 ton!ue2 and ace are)ndin!s associated with hy$erkalemia2 which istransient and results rom transient hy$oaldosteronism

when the adenoma is remo*ed" +remors2 dia$horesis2and consti$ation aren5t seen in hy$erkalemia"

usan Ooun!2 a 7@9year9old )nancial oQcer2 has beene-hibitin! si!ns and sym$toms which lead herurolo!ist to sus$ect the ade0uacy o her urinaryunction" :e!innin! with the least in*asi*e tests2 whicho the ollowin! would you e-$ect the $hysician to$rescribe to assess kidney unction% Choose all correcto$tions"a& :lood urea nitro!en ;:UN& le*elb& Creatinine clearancec& An!io!ra$hyd& All o$tions are correctC& An!io!ra$hyAn!io!ra$hy $ro*ides the details o the arterial su$$lyto the kidneys2 s$eci)cally the number and location orenal arteries" Radio!ra$hy shows the sie and $ositiono the kidneys2 ureters2 and bladder" A C+ scan is useulin identiyin! calculi2 con!enital abnormalities2obstruction2 inections2 and $olycystic diseases"Cystosco$y is used or $ro*idin! a *isual e-amination othe internal bladder"

+he nurse is $re$arin! an education $ro!ram on riskactors or kidney disorders" #hich o the ollowin! riskactors would be ina$$ro$riate or the nurse to includein the teachin! $ro!ram%a& 8re!nancyb& Diabetes mellitusc& Neuromuscular disordersd& ?y$otension


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D& ?y$otension?y$ertension2 not hy$otension2 is a risk actor or kidneydisease"

#hich o the ollowin! terms is used to reer to

in1ammation o the renal $el*is%a& 8yelone$hritisb& Interstitial ne$hritisc& Urethritisd& CystitisA& 8yleone$hritis8yelone$hritis is an u$$er urinary tract in1ammation2which may be acute or chronic" Cystitis is in1ammationo the urinary bladder" Urethritis is in1ammation o theurethra" Interstitial ne$hritis is in1ammation o thekidney"

A client with a !enitourinary $roblem is bein!e-amined in the emer!ency de$artment" #hen$al$atin! the client5s kidneys2 the nurse should kee$ inmind which anatomic act%a& +he kidneys are situated Gust abo*e the adrenal!lands"b& +he let kidney usually is sli!htly hi!her than theri!ht one"c& +he kidneys lie between the 6Bth and 63th thoracic*ertebrae"d& +he a*era!e kidney is a$$ro-imately 7 cm ;3%& lon!and 3 to 4 cm ;% to 6%%& wide":& +he let kidney usually is sli!htly hi!her than the ri!htone

+he let kidney usually is sli!htly hi!her than the ri!htone" An adrenal !land lies ato$ each kidney" +hea*era!e kidney measures a$$ro-imately 66 cm ;%%&lon!2 7 to 7"M cm ;3% to 3S%& wide2 and 3"7 cm ;6%&thick" +he kidneys are located retro$eritoneally2 in the$osterior as$ect o the abdomen2 on either side o the*ertebral column" +hey lie between the 63th thoracicand 4rd lumbar *ertebrae"

+rue or False%>FR is $rimarily de$endent on ade0uate blood 1owand ade0uate hydrostatic $ressure"

+rue

+rue or False%+he $rimary unction o the kidney is to e-cretenito!eneous waste $roducts"


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False8rimary unction o kidney is to re!ulate the *olume andcom$osition o e-tracellular 1uids

+rue or False%

#ater is the $rimary substance reabsorbed in thecollectin! duct%

+rue

+rue or False%Atrial Natriuretic Factor ;ANF& is secreted by the ri!htatruim when atrial blood $ressure is low2 and it inhibitsthe action o aldosterone"FalseAtrial Natriuretic Factor ;ANF& is secreted by the ri!htatruim when atrial blood $ressure is low2 and it inhibitsthe action o hi!h antidiuretic hormone ;AD?& or renin oran!iotensin II

+rue or False%Increased $ermeability in the !lomerulus causes losso $roteins into the urine"

+rue

+rue or False%8rosta!landin synthesis by the kidneys causes

*asodilation and increased renal blood 1ow"+rue

A $atient with an obstruction o the renal arterycausin! renal ischemia e-hibits ?+N" Jne actor thatmay contribute to ?+N.

a& increase renin releaseb& increased AD? secretionc& decreased aldosterone secretiond& increased synthesis and release o $rosta!landinsA& Increase Renin ReleaseRenin is released in resonse to decreased :/82 renalischemia2 eosino$hil chemotactic actor ;ECF& de$letion2and other actors a,ectin! blood su$$y to the kidney" Itis they catalyst o the renin9an!iotensin9aldosteronesystem2 which raises :/8 when stimulated" AD? issecreted by the $osterior $ituitary in res$onse to serumhy$erosmolality and low blood *olume" Aldosterone issecreted within the renin9an!iotensin II2 and kidney$rosta!landins lower :/8 by causin! *asodilation"


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A clinical situation in which the increased release oerythro$oietin would be e-$ected is.

a& hy$oe-miab& hy$otension

c& hy$erkalemiad& 1uid o*erloada& ?y$oe-miaErythro$oietin is released when the o-y!en tension othe renal blood su$$ly is low and stimulates $roductiono red blood cells in the bone marrow" ?y$otensioncauses acti*ation o the renin9an!iotensin9aldosteronesystem2 as well as release o AD?" ?y$erkalemisstimulates release o aldosterone rom the adrenalcorte-2 and 1uid o*erload does not directly stimulateactors a,ectin! the kidney"

+he sites where urinary stones are most likely toobstruct the urinary system are at the TTTTTTTTTT andthe TTTTTTTTTTTT"Uretero$el*ic Gunction and Uretero*esical Gunction

+he *olume o urine in the bladder that usually causesthe ur!e to urinate is TTTT mL"3BB937B mL

+otal bladder ca$acity ran!es rom TTTTTTTTT mL toTTTTTTTTT mL"BB96BBBmL

Absor$tion or leaka!e o urine wastes out o theurinary system is $re*ented by the cellularcharacteristics o the TTTTTTT"urothelium

An a!e related chan!e in the kidney that leads tonocturia in an older adult isa& decreased renal massb& decreased detrusor muscle tonec& decreased ability to conser*e sodiumd& decreased ability to concentrate urineD& decreased ability to concentrate urine

+he decreased ability to concentrate urine results in anincreased *olume o dilute urine2 which does notmaintain the usual diurnal elimination $attern" Adecrease in bladder ca$acity also contributes tonocturia2 but decreased bladder muscle tone results inurinary retention" Decreased renal mass decreases renalreser*e2 but unction is !enerally ade0uate undernormal circumstances"


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Durin! $hysical assessment o the urinary system2 thenursea& auscultates the lower abdominal 0uadrants or 1uidsounds

b& $al$ates an em$ty bladder at the le*el o thesym$hysis $ubisc& $ercusses the kidney with a )rm blow at the$osterior costo*ertebral an!led& $ositions the $atient $rone to $al$ate the kidneyswith a $osterior a$$roachc& $ercusses the kidney with a )rm blow at the $osteriorcosto*ertebral an!le

+o assess or kidney tenderness2 the nurse strikes the)st o one hand o*er the dorsum o the other hand atthe $osterior costo*ertebral an!le" +he u$$er abdominal

0uadrants and costo*ertebral an!les are auscultated or*ascular bruits in the renal *essels and aorta2 and anem$ty bladder is not $al$able" +he kidneys are $al$atedthrou!h the abdomen2 with the $atient su$ine"

A urinalysis o a urine s$ecimen that is not $rocessedwithin 6 hour may result in erroneous measurement oa& !lucoseb& bacteriac& s$eci)c !ra*ityd& white blood cells:& bacteriabacteria in warm urine s$ecimens multi$ly ra$idly2 andalse or unreliable bacterial counts may occur with oldurine" >lucose2 s$eci)c !ra*ity2 and #:Cs do notchan!e in urine s$ecimens2 but $? becomes morealkaline2 R:Cs are hemolyed2 and casts maydisinte!rate"

#hich o the ollowin! urine s$eci)c !ra*ity *alueswould indicate to the nurse that the $atient is

recei*in! e-cessi*e I 1uid thera$y%a& 6"BB3b& 6"B6Bc& 6"B37d& 6"B4Ba& 6"BB3A urine s$eci)c !ra*ity o 6"BB3 is low2 indicatin! dluiteurine and the e-cretion o e-cess 1uid" Fluid o*erload2diuretics2 or lack o AD? can cause dilute urine" Normalurine s$eci)c !ra*ity indicates concentrated urine thatwould be seen in dehydration"


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#hile carin! or a @@9year old woman who has aurinary catheter2 the nurse monitors the $atient or thede*elo$ment o a U+I" +he clinical maniestations the$atient is most likely to e-$erience include.a& cloudy urine and e*er

b& urethral burnin! and blood urinec& *a!ue abdominal $ain and disorientationd& su$ra$ubic $ain and sli!ht decline in bodytem$eraturec& *a!ue abdominal $ain and disorientation

+he usual classic sym$toms o U+I are oten absent inolder adults2 who tend to e-$erience nonlocaliedabdominal $ain rather than dysuria and su$ra$ubic $ain"

+hey may also e-$erience co!niti*e im$airmentcharacteried by conusion or decreased le*el oconsciousness"

A woman with no h- o U+Is who is e-$eriencin!ur!ency2 re0uency2 and dysuria comes to the clinic2where a di$stick and microsco$ic urinalysis indicatebacteriuria" +he nurse antici$ates that the $atient willa& need to ha*e a blood s$ecimen drawn or a C:C andkidney unction testb& not be treated with medications unless shede*elo$s a e*er2 chills2 or 1ank $ainc& be re0uested to obtain a clean9catch midstreamurine s$ecimen or culture and sensiti*ity

d& be treated em$irically with +(89(X :actrim or 4days"d& be treated em$irically with +(89(X :actrium or 4daysUnless a $atient has a h- o recurrent U+Is2 +(89(X ornitrourantoin is usually used to em$irically treat aninitial U+I without a culture and sensiti*ity test"Asym$tomatic bacteriuria does not Gustiy tc2 butsym$tomatic U+Is should always be treated"

Documents

NCLEX Urinary